Organization
ESTACADA FAMILY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORNELIUS GEHRED DDS (PRESIDENT)
(503) 630-4218
Entity
Organization
Contact information
Practice address
630 N BROADWAY ST, ESTACADA, OR 97023-8584
(503) 630-4218
Mailing address
PO BOX 929, ESTACADA, OR 97023-0929
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/29/2020
Last updated
09/29/2020
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